Introduction to the Active Living Research Reference List January – July 2008

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S. Byrne, M. Wake, D. Blumberg and M. Dibley. (2008). Identifying priority areas for longitudinal research in childhood obesity: Delphi technique survey. International Journal Of Pediatric Obesity. 3, 120-122.

In 2005, the Australian Child and Adolescent Obesity Research Network (ACAORN) addressed the question, "What childhood and adolescent obesity research questions remain to be addressed through longitudinal research?" Using the Delphi Technique, ACAORN members individually generated then refined and prioritised a set of research ideas. When delegates to a national child obesity symposium repeated the final (prioritisation) step, a strong concordance in rankings was evident. The highest-priority questions related to modifiable environmental risk/protective factors; parental and family factors; longitudinal relationships between development of obesity and physical, social and mental health; predisposing prenatal and early childhood patterns of growth and nutrition; identification of stronger early markers of later chronic disease risk; and better understanding of the natural course of overweight in childhood. These prioritised research questions could be proactively provided to funding bodies, quoted to support research applications, and used to stimulate secondary data analysis and collaborations between research groups.

P. D. B. Campagnolo, M. R. Vitolo, C. M. Gama and A. T. Stein. (2008). Prevalence of overweight and associated factors in southern Brazilian adolescents. Public Health. 122, 509-515.

Objective: The aim of this study was to determine the prevalence of overweight in adolescents in a southern Brazilian city, and ascertain gender differences and association with socio-economic and demographic conditions, family factors and individual behaviours. Methods: Cross-sectional population-based study with random cluster sampling of households, including 722 adolescents (10-19 years), from a city in southern Brazil. Body mass index (BMI) was calculated based on the National Center for Health and Statistics reference curve, defining overweight as BMI >= 85th percentile. Results: Prevalence of overweight was 17% in girls and 19% in boys. In multivariate Poisson regression, chronic illness in parent(s) and household of up to four people were associated with overweight in boys, whereas low fibre intake, more hours spent watching television and regular exercise were associated with overweight in girls. Conclusion: The prevalence of overweight in Brazilian adolescents is high, with gender differences in associated factors. Health workers in schools and public health services should be aware of these differences in order to improve preventive and therapeutic strategies in this age group.

G. M. Cardon and I. M. M. D. Bourdeaudhuij. (2008). Are preschool children active enough? Objectively measured physical activity levels. 79, 326-332.

C. Chan. (2008). Childhood obesity and adverse health effects in Hong Kong. Obesity Reviews. 9, 87-90.

Hong Kong soon became aware of the importance of ensuring the optimum growth of their children with growth standards for Hong Kong being set out in 1962. By 1972 it was already clear that childhood obesity was emerging as a problem and increasing in prevalence and by 1987 an international workshop on nutrition, held in Hong Kong, was being alerted to this issue. Then 10 years later obesity featured as a major issue in the programme of the Asian Congress of Pediatrics with the local contributors highlighting the evidence already available in Hong Kong of the wide range of metabolic, cardiovascular, physical and psychological complications of obesity in the local community. The school health service was given a prominent role and there are now guidelines not only in relation to the standards of school lunches but also for the need to enhance the physical activity of children and involve a new educational community wide approach as part of a major co-coordinated effort within Hong Kong. Professional and community workers together with the government now have a comprehensive determination to tackle the challenge of obesity prevention. So Hong Kong intends to play a major role in the international response to the formation of the Global Alliance for the prevention of obesity and its associated chronic diseases.

C. Chang, W. Liu, X. Zhao, S. Li and C. Yu. (2008). Effect of supervised exercise intervention on metabolic risk factors and physical fitness in Chinese obese children in early puberty. Obes Rev. 9 Suppl 1, 135-41.

The aim of this paper was to study the effect of long-term supervised exercise-induced weight maintenance on metabolic risk factors and physical fitness in obese children in early puberty. A total of 49 obese children aged 12-14 years were divided into control and exercise groups. The children in the exercise group accepted exercise intervention supervised by a professional sports teacher for 9 of the 12 months. All participants in both groups received health education once every 3 months. Anthropometry and fasting serum lipids, glucose, insulin and homeostatic model assessment for insulin resistance (HOMA-IR) were measured at months 0, 3, 9, 12 of the intervention. Physical fitness was determined before and after intervention. After the intervention (i) BMI was reduced by 0.6 (P < 0.05) in the exercise group, but increased by 0.5 (P < 0.05) in the control group, compared with the pre-intervention level at the end of 9-month intervention; (ii) Triglyceride levels in the exercise group significantly decreased by 23.1% by 3 months (P < 0.05), and by 30.2% after 9 months (P < 0.05), but increased by 50% (P < 0.05) in the control group; high density lipoprotein-cholesterol (HDL-C) decreased more by 35% (P < 0.05) in the controls than in the exercise group (P < 0.05); (iii) Fasting serum glucose, insulin level and HOMA-IR decreased, respectively, by 23.1%, 36.6% and 48.5% in the exercise group at 9 months (P < 0.05), whereas glucose levels increased by 10.9% (P < 0.05) in the control group; (iv) Exercise performance, such as upper- and lower-limb strength, flexibility and endurance, were enhanced by 17.9%, 12.3%, 22.3% and 20.4% (P < 0.01), respectively and (v) At 12 months, i.e. 3 months after terminating the supervised exercise, serum triglycerides, glucose, insulin and HOMA-IR level all returned to the pre-intervention level. Supervised decrement exercise can effectively slow the progress of obesity, improve insulin sensitivity and metabolic risk factors, but once the supervised exercise is stopped, the health benefits weaken or vanish. The key to helping these obese children is for them to cultivate good exercise habits which are sustained throughout their lives.

V. J. Cleland, T. Dwyer and A. J. Venn. (2008). Physical activity and healthy weight maintenance from childhood to adulthood. Obesity. 16, 1427-1433.

The objective of this study was to determine whether change in physical activity was associated with maintaining a healthy weight from childhood to adulthood. This prospective cohort study examined 1,594 young Australian adults (48.9% female) aged 27-36 years who were first examined at age 9-15 years as part of a national health and fitness survey. BMI was calculated from measured height and weight, and physical activity was self-reported at both time points; pedometers were also used at follow-up. Change in physical activity was characterized by calculating the difference between baseline and follow-up z-scores. Change scores were categorized as decreasing (large, moderate), stable, or increasing (large, moderate). Healthy weight was defined in childhood as a BMI less than international overweight cutoff points, and in adulthood as BMI< 25 kg/m(2). Healthy weight maintainers were healthy weight at both time points. Compared with those who demonstrated large relative decreases in physical activity, females in all other groups were 25-37% more likely to be healthy weight maintainers, although associations differed according to the physical activity measure used at follow-up and few reached statistical significance. Although younger males whose relative physical activity moderately or largely increased were 27-34% more likely to be healthy weight maintainers than those whose relative physical activity largely decreased, differences were not statistically significant. In conclusion, relatively increasing and stable physical activity from childhood to adulthood was only weakly associated with healthy weight maintenance. Examining personal, social, and environmental factors associated with healthy weight maintenance will be an important next step in understanding why some groups avoid becoming overweight.

A. E. Collins, B. Pakiz and C. L. Rock. (2008). Factors associated with obesity in Indonesian adolescents. International Journal Of Pediatric Obesity. 3, 58-64.

Objective. To investigate adolescent eating, activity, and behavioral patterns, and attitudes and their associations with obesity in selected communities in Indonesia. Design. A cross-sectional questionnaire and physical measurement-based study in three communities of varying modernization levels in Indonesia (Yogyakarta, Kuta, and Jakarta). Subjects. 1758 middle school students (aged 12-15 years) recruited at six different schools: one public and one private school in each of the three target communities. Measurements. The questionnaire collected data on demographic characteristics (age, gender, ethnicity, estimated household income); fast food eating habits (frequency, types of food/restaurant, general beliefs about fast foods),television, computer, and Play Station usage; physical activity (hrs/wk of participation in physical activity, transportation means for attending school); and eating habits (frequency of consuming selected foods and beverages). Student's height and weights were obtained, body mass index BMI: weight [kg]/height [m(2)]) was calculated, and obesity was defined as >= 95%, using the BMI-for-age cut-offs from the Centers for Disease Control and Prevention (CDC) charts. Results. Chi-square analysis revealed associations between obesity and community setting, family income, use of a computer or Play Station, type of transportation to school, and beliefs about fast foods (P < 0.01). According to the logistic regression analysis, adolescents from families with incomes over Rp 2 mil were three times as likely to be obese (95% CI 1.9, 4.9) and boys were 2.6 times more likely to be obese (95% CI 1.5, 4.5). Conclusion. Greater likelihood of obesity among Indonesian adolescents who spend greater amounts of time using a computer or Play Station suggests that such sedentary activities may be replacing physical activity, promoting an energy imbalance, and subsequently, an increased risk for obesity.

M. A. Cortina, K. Kahn, M. Fazel, T. Hlungwani, S. Tollman, A. Bhana, D. Prothrow-Stith and A. Stein. (2008). School-based interventions can play a critical role in enhancing children's development and health in the developing world. Child Care Health Dev. 34, 1-3.

D. A. Dennison, Z. Yin, D. Kibbe, S. Burns and F. Trowbridge. (2008). Training health care professionals to manage overweight adolescents: experience in rural Georgia communities. J Rural Health. 24, 55-9.

CONTEXT: The obesity epidemic threatens the present and future health of adolescents in the United States. Yet, health care providers lack specific training for pediatric obesity assessment and management. PURPOSE: This study examined the adherence of rural Georgia primary care practitioners to an overweight adolescent management protocol. The study also documented the prevalence of obesity-associated physiological and behavioral risk factors among overweight adolescent patients. METHODS: Ten rural clinics (58 providers) were recruited and received a 90-minute adolescent overweight assessment and management training session. Select biochemical, dietary, physical activity, and physical inactivity behaviors were assessed in overweight adolescent patients. Medical charts were abstracted to assess practitioner compliance with an overweight assessment protocol and patient adherence to a 16-week follow-up visit. FINDINGS: Providers were receptive to training and complied with the recommended protocol. Eighty-five overweight adolescents were assessed, but only 49 (57%) completed the scheduled 16-week follow-up visit. Physical, biochemical, and behavioral assessments revealed that 13%-27% of the participants had abnormal levels of lipids, fasting glucose, and glucose/insulin ratio, and 80.5% had waist circumferences above the 90th percentile. CONCLUSIONS: Practitioners complied with the assessment and follow-up protocol, leading to the discovery of previously unrecognized risk factors in many overweight adolescent patients. Lack of patient adherence to follow-up was the greatest limiting factor for obesity management. Further efforts are needed to implement and evaluate training to improve the management of adolescent overweight, especially in rural communities.
P. P. DiNapoli and J. B. Lewis. (2008). Understanding school-age obesity: through participatory action research. MCN Am J Matern Child Nurs. 33, 104-10.

PURPOSE: This study aimed to assess current levels of overweight (obesity) and fitness among school students using objective data. METHODS: School-based action research teams were recruited statewide by the New Hampshire Healthy Schools Coalition, the state team of the National Action for Healthy Kids Coalition. Action teams consisted of a physical education teacher, a school nurse, and a school administrator. Data were collected from 6,511 student participants aged 6 to 14 years, which was a representative cross-section from New Hampshire school districts. Key variables of interest in the study were body mass index, and ability to pass five fitness tests using FITNESSGRAM. Pearson's correlation was used to assess the relationships among body mass index, age, gender, and the percent of students that passed FITNESSGRAM tests. RESULTS: The ability of participants to pass the FITNESSGRAM tests declined markedly with age and differed between boys and girls, although the healthy fitness zones for any particular test was lower for girls. Body mass index was significantly negatively correlated with performance on all tests. Age was also statistically negatively correlated with performance on all tests; the relationship between gender and performance on the tests was less striking. CLINICAL IMPLICATIONS: Results reflected an increase in the prevalence of overweight school children, even in New Hampshire, which is purported to be one of the healthiest states in the nation. Results offered evidence that body mass index is a valid proxy measure for fitness levels and that fitness programs are necessary to effectively combat the obesity epidemic. Evidence-based changes need to be implemented to address obesity-related factors in schools, because children spend many of their waking hours in that setting. Physical activity during recess and physical education classes could help to increase energy expenditure and develop sound minds and bodies. Schools should consider the development of school-based wellness teams to advise and advocate improved school-based wellness policies. School nurses can take an active part in these initiatives.

M. M. Driskell, S. Dyment, L. Mauriello, P. Castle and K. Sherman. (2008). Relationships among multiple behaviors for childhood and adolescent obesity prevention. Prev Med. 46, 209-15.

BACKGROUND: Curbing the epidemic of childhood and adolescent obesity requires impacting multiple behaviors. This article examines the interrelationships of physical activity, fruit and vegetable consumption, and limiting television time among elementary, middle, and high school students. METHODS: Nationwide samples of students in grades 4 through 12 (n=4091) completed self-administered questionnaires assessing Transtheoretical Model constructs and behavioral indicators for physical activity, fruit and vegetable consumption, and limiting television time. Analyses were conducted to compare the prevalence of students at-risk for the target behaviors across the age groups and to examine the interrelationships of the target behavior risks. RESULTS: Across the three age groups, physical activity and fruit and vegetable consumption declined, while limiting TV time increased. In addition, high school students had the greater number of behavioral risks. Across all three samples, being at-risk for one behavior almost always significantly increased the odds of being at-risk for another behavior. CONCLUSION: The findings of this study provide further evidence for the need for early promotion of healthy lifestyle behaviors. The relationships among the target behaviors in three samples strongly support a multiple behavior approach for obesity prevention. Transtheoretical Model-based tailored interventions are currently being used to change multiple behaviors without overwhelming students.

S. A. Dugan. (2008). Exercise for preventing childhood obesity. Phys Med Rehabil Clin N Am. 19, 205-16, vii.

Childhood obesity is a key public health issue in the United States and around the globe in developed and developing countries. Obese children are at increased risk of acute medical illnesses and chronic diseases-in particular, osteoarthritis, diabetes mellitus, and cardiovascular disease, which can lead to poor quality of life; increased personal and financial burden to individuals, families, and society; and shortened lifespan. Physical inactivity and sedentary lifestyle are associated with being overweight in children and adults. Thus it is imperative to consider exercise and physical activity as a means to prevent and combat the childhood obesity epidemic. Familiarity with definitions of weight status in children and health outcomes like metabolic syndrome is crucial in understanding the literature on childhood obesity. Exercise and physical activity play a role in weight from the prenatal through adolescent time frame. A child's family and community impact access to adequate physical activity, and further study of these upstream issues is warranted. Recommended levels of physical activity for childhood obesity prevention are being developed.

M. J. Edmonds, K. J. Ferreira, E. A. Nikiforuk, A. K. Finnie, S. H. Leavey, A. M. Duncan and J. A. Randall Simpson. (2008). Body weight and percent body fat increase during the transition from high school to university in females. J Am Diet Assoc. 108, 1033-7.

A critical period for weight gain may occur during the transition from high school to university. This descriptive, noncontrolled cohort study of 116 healthy females examined the effect of this transition over three study visits in first year university. The main outcome measure was body weight; others were height, body composition, waist circumference, dietary intake, and participation in physical and sedentary activities. Difference among study visits was determined by repeated measures analysis of variance; multiple regression examined changes in energy intake and physical and sedentary activities as predictors of final weight. Weight increased (P<0.001) by 2.4 kg (61.4 to 63.8 kg) during the entire course of the study. Other increases (P<0.001) included: body mass index (calculated as kg/m(2)), 22.3 to 23.1; percent body fat, 23.8% to 25.6%; and waist circumference, 76.9 to 79.4 cm. Dietary energy intake did not increase; vigorous physical, but not strength building, activities increased; television use decreased; and computer use increased (P<0.03 for all): however, these changes were not predictive of final weight. A change (decrease) in moderate physical activity was, however, an important predictor of final weight. Females making the transition to university gained 2.4 kg; weight gain during this formative period may be modified by lifestyle activities.

J. E. Eichner, W. E. Moore, G. Perveen, C. E. Kobza, K. E. Abbott and A. L. Stephens. (2008). Overweight and Obesity in an Ethnically Diverse Rural School District: The Healthy Kids Project. Obesity (19307381). 16, 501.

The article discusses a study which aimed to describe the prevalence of overweight and obesity in a racially mixed rural area where Native American, Hispanic, African American, and white children reside. In this study, the body mass index (BMI) was calculated and the International Obesity Task Force reference was used to classify children into BMI categories.

J. C. Eisenmann, R. T. Bartee, D. T. Smith, G. J. Welk and Q. Fu. (2008). Combined influence of physical activity and television viewing on the risk of overweight in US youth. International Journal Of Obesity. 32, 613-618.

Objective: The purpose of this study was to examine the combined influence of physical activity (PA) and television viewing (TV) on the risk of overweight in US youth ages 14 - 18 years. Research design and methods: Cross- sectional data from a nationally representative sample of approximately 13 600 US high school students participating in the 2001 Centers for Disease Control and Prevention Youth Risk Behavior Survey (YRBS) were examined. Participants were cross- tabulated into nine PA - TV groups according to the level of moderate (MPA) or vigorous PA (VPA) (low: <= 2 days per week; moderate: 3 - 5 days per week; high: 6 - 7 days per week) and TV (low: <= 1 h per day; moderate: 2 - 3 h per day; high: >= 4 h per day). The referent group was the low TV/ high PA group. The body mass index was used to determine overweight and obesity based on the International Obesity Task Force reference values. Logistic regression was used to examine the influence of TV and PA on the odds of overweight in boys and girls, while controlling for age and ethnicity. Results: Boys and girls watching low levels of TV did not have increased odds of overweight regardless of PA level with the exception of girls with low TV/ low VPA (odds ratio (OR) 1.48). Girls who watched moderate and high levels of TV had increased odds of overweight at any level of MPA or VPA (OR 1.24 - 3.11). In girls, the odds of overweight increased in a graded manner across PA levels for both the moderate and high levels of TV. Girls with high TV/ low VPA had the highest odds of overweight (OR 3.11). In general, most of the associations were stronger in girls compared to boys. Conclusion: The results highlight the importance of considering both PA and TV as risk factors for overweight in adolescents.

A. Eyler, J. Baldwin, C. Carnoske, J. Nickelson, P. Troped, L. Steinman, D. Pluto, J. Litt, K. Evenson, J. Terpstra, R. Brownson and T. Schmid. (2008). Parental Involvement in Active Transport to School Initiatives: A Multi-Site Case Study. American Journal of Health Education. 39, 138.

The article explores the parental perception and participation in active transportation to and from school (ATS) initiatives. A study was conducted which involved sixty-nine key informants, including 10 parents, that were interviewed at nine different elementary schools. Results showed that parental support was a significant component for ATS success, that the roles of parents varied, and that parents participated in ATS for a particular reason. Thus, it is concluded that parents can be essential resources in school ATS programs, their level of participation can differ from coordinating a program to lead a walking group, and that participation among parents can promote a successful initiative.

N. J. Farpour-Lambert, A. Nydegger, S. Kriemler, D. L'Allemand and J. J. Puder. (2008). [How to treat childhood obesity? Importance of primary prevention]. Rev Med Suisse. 4, 533-6.

The prevalence of childhood obesity increases dramatically. First signs of cardiovascular diseases and type 2 diabetes appear early in life. The treatment of childhood obesity aims at weight maintenance during growth, normalization of body mass index at long-term and prevention of complications. The family based behavioural therapy is a promising approach. It provides simultaneous treatment for the overweight parent and child in order to modify the family environment, to provide role models and support for child behaviour changes. However, this requires group leaders and multiple counselors to meet with families. The treatment should be initiated as soon as possible, as its efficacy is reduced after the onset of puberty. Early preventive interventions that aim to modify both individual's behaviours and the environment are needed.

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